2014 Tribal Consultation Prescription Drug Abuse in Indian Country

2014 Tribal Consultation
U.S. Department of Health and Human Services
Regions VII and VIII
Prescription Drug Abuse in
Indian Country
April 8, 2014
Prescription Drug Abuse:
The Problem
Kimberly Patton, PsyD
HHS/HRSA/ORO
Public Health Analyst/Behavioral Health Liaison
Denver Regional Office
What is Prescription Drug Abuse?


The intentional use of a medication without a
prescription of one’s own
– In a way other than as prescribed
– Or for the experience or feeling the drug
causes
Nonmedical use of psychotherapeutics
includes nonmedical use of any prescriptiontype pain relievers, tranquilizers, stimulants, or
sedatives.
3
Drug Overdose Deaths
 In 2010, 60 percent of drug overdose deaths in
the U.S. were related to prescription drugs.
 Of these 75 percent involved opioid pain
relievers, and 30 percent involved
benzodiazepines (tranquilizers)
4
Prescription Drug Abuse is a Significant
Problem in the United States
 Prescription drugs are the second-most
abused category of drugs in the U.S.
following marijuana.
 In 2012, an estimated 6.8 million persons
aged 12 or older, or 2.6 percent of the
population, abused or misused prescription
drugs
5
Most Commonly Abused Prescription Drugs
 Number of estimated prescription drug users
aged 12 or older, 2012:




Pain relievers/opioids - 4.9 million
Tranquilizers - 2.1 million
Stimulants - 1.2 million
Sedatives - 270,000
6
Most Commonly Abused Prescription Drugs
 Opioids
– Pain medication
– Percocet, Oxycontin, Vicodin
 Tranquilizers
– Used to treat anxiety and insomnia, and severe
mental illness
– Central nervous system depressants
– Minor and major tranquilizers
– Valium, Thorazine
7
Most Commonly Abused Prescription Drugs
 Stimulants
– Used to treat ADHD and narcolepsy
– Ritalin, Adderall
 Sedatives
– Used to treat anxiety and sleep problems
– Central nervous system depressants
– Barbiturates (Seconal) and benzodiazepines
(Xanax)
8
First Time Users
 In 2012, approximately 2.4 million persons
aged 12 or older used prescription drugs
nonmedically for the first time within the past
year
– Averages to about 6,700 new users per day
 More than 26 percent of all past year first time
illicit drug users reported that their first drug
was prescription pain relievers
– Averages to more than 5,000 new users per day
9
Source of Nonmedical Pain Relievers Among Persons
Aged 12 or Older Who Used in the Past 12 Months
54.0%
10.9%
19.7%
4.3%
From a friend Bought drug Prescription
or relative for from a friend
free
or relative
Drug
from one
dealer/other
doctor
stranger
0.2%
Internet
10
Groups at Greatest Risk for Prescription
Drug Abuse/Overdose
 Men aged 25-54 have the highest prescription
drug overdose rates, although rates for women
25-54 are increasing faster.
 People in rural counties are about two times as
likely to overdose on prescription painkillers as
people in big cities.
 Teens/young adults
 Soldiers and veterans
11
Groups at Greatest Risk for Prescription
Drug Abuse/Overdose
 Individuals with occupational injuries
 Individuals with mental illness or past
substance abuse
 Whites and American Indians or Alaska
Natives are more likely to overdose on
prescription painkillers.
12
Emergency Room Visits
 Emergency room visits for prescription
drug abuse more than doubled between
2004 and 2011.
 In 2011, more than 1.4 million emergency
room visits were related to prescription
drugs.
13
Treatment
 The rate for non-heroin, opiate-related
admissions to substance abuse treatment,
for those age 12 or older, was 400 percent
higher in 2012 than in 2000
14
What is Driving This High Prevalence?
 Misperceptions about their safety
– Because these medications are prescribed by
doctors, many assume that they are safe to
take under any circumstances. This is not the
case. Prescription drugs act directly or indirectly
on the same brain systems affected by illicit
drugs
15
What is Driving This High Prevalence?
 Increasing environmental availability
– Between 1991 and 2010, prescriptions for
stimulants increased from 5 million to nearly 45
million and for opioid analgesics from about
75.5 million to 209.5 million
 Varied motivations for their abuse
– Underlying reasons include: to get high; to
counter anxiety, pain, or sleep problems; or to
enhance cognition
16
Opioid Pain Reliever Sales
 The sharp rise in opioid overdose deaths
closely parallels an equally sharp increase in
the prescribing of these drugs
 Opioid pain reliever sales in the United States
quadrupled from 1999 to 2010
17
Financial Costs
 In addition to the human costs, the epidemic of
prescription drug overdose imposes a major
financial toll
 Nonmedical use of opioid pain relievers costs
U.S. insurance companies up to $72.5 billion
annually in healthcare expenditures
18
Region VIII States
 The severity of the epidemic varies widely
across U.S. states, which is reflected in
Region VIII states
19
Drug Overdose Rates by Region VIII State–2010
Rates per 100,000 population
16.9
12.4
12.7
12.9
15
6.3
3.4
U.S.
Colorado Montana
North
South
Dakota
Dakota
Utah
Wyoming
20
Nonmedical Use of Prescription Pain Relievers in
the Past Year among Persons Aged 12 or Older,
by Region VIII State: 2010-2011
Nonmedical Use of
Prescription Pain Relievers
National
4.6%
Colorado
6.0%
Montana
4.8%
Wyoming
4.7%
Utah
4.3%
North Dakota
3.8%
South Dakota
3.7%
21
Prescription Drug Abuse – American Indians
 Data indicate high usage of illicit drugs by
American Indians and outline the need for
targeted resources and outreach
 American Indian and Alaskan Native
populations show high percentages of:
– Lifetime abuse (64.8 percent)
– Past year illicit drug use (27.1 percent)
– Current non-medical use of prescription drugs
(6.2 percent)
22
Drug Overdose Death Rates per 100,000 by
Ethnicity
All Drugs
Prescription
Drugs
Opioid Pain
Relievers
Illicit Drugs
11.9
6.5
4.8
2.8
13.2
7.4
5.6
2.8
Hispanic
6.1
3.0
2.1
2.5
Non-Hispanic
14.7
8.4
6.3
2.9
Black
8.3
3.0
1.9
4.0
Asian/Native
Hawaiian or PI
1.8
1.0
0.5
0.6
American Indian/
Alaska Native
13.0
8.4
6.2
2.7
Overall
Race/Ethnicity
White
23
American Indians/Alaska Natives
 12.7 percent of American Indians/Alaskan
Natives age 12 or older are current users of
illicit drugs
24
Current Rate of Illicit Drug Use Among Persons
Aged 12 or Older by Ethnicity, 2012
7.8%
8.3%
9.2%
11.3%
12.7%
14.8%
3.7%
Asian
NH/PI Hispanic
White
Black
AI/AN
Two or
more
races
25
Some Good News
 Among youths aged 12 to 17, the rate of
current nonmedical use of prescription drugs
decreased from 4.0 percent in 2002 to 2.8
percent in 2012
 The rate of nonmedical pain reliever use
declined during this period from 3.2 to 2.2
percent among youths
26
HHS Inter-agency Collaboration
on Prescription Drug Abuse
CDR Christina Mead, PharmD
US Public Health Service
HHS/HRSA/ORO
Area/Regional Pharmacy Consultant
Denver Regional Office
What Can HHS do?
 The U.S. Department of Health and
Human Services is committed to
reducing prescription drug abuse and
its negative outcomes
 HHS Operating Divisions are
collaborating across agencies to align
and implement programs that address
prescription drug abuse in Region 8
(CO, WY, ND, SD, UT, WY)
HHS Collaboration
 HHS Region 8 Agencies:
– Health Resources and Services
Administration (HRSA)
– Substance Abuse and Mental Health
Services Administration (SAMHSA)
– Indian Health Service (Great Plains Area
Office - formerly Aberdeen Area)
Great Plains Area Indian Health
Service
 Leadership from the Area Office formed a
Prescription Drug Abuse Task Force
consisting of various clinical disciplines
and administrators from multiple service
units
 Meet on a weekly basis
HHS Collaboration
 HRSA and SAMHSA leadership and
subject matter experts partnered with the
Great Plains Area Office to assist the Task
Force in forming and implementing a
strategic plan
Great Plains Strategic Plan
 Strategy Areas
–
–
–
–
Clinical Practice
Prescription Drug Monitoring Program
Education
Disposal Plan
Clinical Practice
 Pain Medication Contract
– Area-wide standard contract
– Regular competency training for providers
 Drug and Alcohol Screening
– Integrated into treatment plan
– Training for all providers
 Prescribing Guidelines
– Standard practices
Prescription Drug Monitoring Program
 A PDMP is a statewide electronic database which
collects designated data on substances dispensed in
the state
 The PDMP is housed by a specified statewide
regulatory, administrative, or law enforcement
agency
 The state agency housing the PDMP distributes
data to individuals who are authorized under state
law to receive this data for purposes of their
profession
Source: http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm#1
Education
 Patient and community focus
 Emphasis on prevention
 To enhance partnerships and community
collaboration
– Law enforcement, religious institutions,
community centers, community health
centers, behavioral health providers funded
outside of the Indian Health Service
Disposal Plan
 Develop a strategy to remove unused
controlled-substances from homes
 Define and educate an Area-wide
prescription drug disposal plan
 Partner with the Drug Enforcement
Administration
Contact Information
Kim Patton, PsyD
303-844-7865
[email protected]
CDR Christina Mead, PharmD
303-844-7875
[email protected]
37
SAMHSA
Mission
Reduce the impact
of substance abuse
and mental illness
on America’s
communities
Behavioral Health Is Essential To Health
Prevention Works
Treatment Is Effective
People Recover
Prescription Drugs
 Most Prevalent Illicit Drug Problem
After Marijuana
o 1 in 22 reported misuse/abuse of prescription meds
o US consumes 99% of world’s hydrocodone
 Emergency Room Visits
o Non-medical use of ADHD stimulant medications
nearly tripled from 5,212 to 15,585 visits (2005 –
2010)
 Treatment Admissions
o 569.7% increase Benzodiazepine & pain med use
(2000-2010)
ONDCP Strategy to Prevent & Reduce
Prescription Drug Abuse
 Education
Parents, youth, patients & prescribers
 Monitoring
Implement Prescription Drug
Monitoring Programs in every state to reduce
diversion, enhance ability to share data across states
and encourage use by health professionals
 Proper medical disposal
DEA proposed rules
 Enforcement Eliminate improper prescribing
practices and stop pill mills
EPIDEMIC: RESPONDING TO AMERICA’S PRESCRIPTION DRUG ABUSE CRISIS , ONDCP 2011
SAMHSA’s Strategies for Reducing
Prescription Drug Abuse
 Prevention and early intervention
 Prescriber and patient education
 Enhanced treatment access and quality
 Overdose prevention and rapid intervention
 Appropriate regulation
SAMHSA: Prescription Drug Abuse Strategy
Prevention and Early Intervention:
 Screening, Brief Intervention, and Referral to Treatment
(SBIRT)
o Screening individuals in primary care settings (e.g.,
clinics, hospitals, nursing homes) for risk of substance
abuse
o Helping patients accept the need for treatment
o Helping patients obtain appropriate treatment
services.
SAMHSA: Prescription Drug Abuse Strategy
Prescriber and Patient Education:
 Physician Clinical Support System for Opioids (PCSS-O)
o
Free mentoring for practicing physicians on clinical topics such as
prescribing opioids for chronic pain and office-based treatment of
opioid-dependent patients www.pcss-o.org
 Physician Clinical Support System for Buprenorphine (PCSS-B)
o
Free mentoring for practicing physicians from experts on officebased treatment of opioid addiction with buprenorphine
www.pcssb.org.
 SAMHSA has published information for patients and the public
on prescription drug abuse and its treatment www.samhsa.gov
SAMHSA: Prescription Drug Abuse
Strategy
Enhanced Treatment Access and Quality
 Treatment Improvement Protocols (TIPs)
o
Medication Assisted Treatment
o
Managing Chronic Pain
 Opioid Brief Guide for primary care physicians
on how to use FDA-approved medications to
treat opioid addiction in the medical office.
SAMHSA: Prescription Drug Abuse Strategy
Overdose Prevention and Rapid Intervention:
 Opioid Overdose Toolkit
o In practical, plain language, the kit outlines steps
to take to prevent and treat opioid overdose
(including the use of naloxone)
o It also identifies important resources
for patients, families, prescribers, and
communities.
SAMHSA: Prescription Drug Abuse Strategy
Prescription Drug Monitoring Programs:
 PDMP-EHR Integration and Interoperability Expansion
Grants (2012-13):
o Improve real-time access to PDMP data by integrating
PDMPs with existing EHR technologies (hospital ERs,
outpatient facilities, retail pharmacies, etc.)
o Increase the interoperability of PDMPs across state lines
o 9 states are funded, as well as an evaluation by CDC.
•
North Dakota School of Pharmacy (2013)
SAMHSA’s Technical Assistance Centers
 Tribal Training &Technical Assistance Center
www.samhsa.gov/tribal-ttac
 ATTC Regional Centers
www.attcnetwork.org
o Central Rockies ATTC (University of Utah) – Region VIII
 ATTC National Focus Centers
o American Indian Alaskan Native (University of Iowa)
o ATTC-SBIRT (IRETA, University of Pittsburgh)
 Center for the Application of Prevention Technologies (CAPT)
www.captus.samhsa.gov
 Suicide Prevention Resource Center www.sprc.org
ONDCP Strategy & Tribal Nations
 Drug Enforcement Agency (DEA) National
Drug Take-Back Day
 Office of National Drug Control Policy
and
Bureau of Justice Assistance (BJA )
state-state/state-tribal PDMP linkages/interoperability
 The Alliance of States with Prescription Drug Monitoring
Programs (The Alliance), Brandeis University - PMP Center
of Excellence and IHS creating interoperability between
IHS pharmacies and state PDMPs.
 BJA and National Congress of American Indians (NCAI)
crime investigation training for tribal law enforcement
agencies
Thank You
Charles H. Smith, PhD
Regional Administrator - Region VIII
(Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming)
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
999 18th Street, South Tower, Room 4-342
Denver, CO 80202
303-844-7873 (office)
720-441-9995 (cell)
[email protected]
Tribal Law and Order Act of 2010
and SAMHSA:
an Update from the
Office of Indian Alcohol and Substance Abuse
Rod K. Robinson
Director, Office of Indian Alcohol and Substance Abuse
Substance Abuse and Mental Health Services Administration
HHS Tribal Consultation
April 7-8, 2014
Denver, CO.
Energizing the Tribal Action
Planning Process
Tribal Law and Order Act of 2010
54
 Signed into law July 29, 2010
 Reauthorizes and amends:
Indian Alcohol and Substance
Abuse Prevention and Treatment Act (IASA) of
1986
Goals of TLOA
• Determine the scope of
the SA problem in
AI/AN populations
• Identify the resources
and programs of each
agency relevant to a
coordinated effort
addressing SA in AI/AN
populations
• Coordinate existing
agency programs with
those established under
the Act
• Continued respect for
tribal sovereignty
embedded in all TLOA
activities
SAMSHA and Federal partners carrying out the
Intent of TLOA
Empowered
Feedback/Recommendations
Interdepartmental
Coordinating
Committee
Carry out TLOA
Directives, provide
Guidance for Action
OIASA
Align, Leverage and
Coordinate
IASA
Membership
Pool of Resources &
Response Protocol for
Ideas and Input
Regional
POC’s
Engage with Tribes &
Provide Linkage to
OIASA
Tribes
Lead the Community &
Federal Partners to
Address Substance
Abuse Concerns
TCC’s
Local Partnerships
that create Plans &
Resources in the
Community
TAP’s
Tribe Specific Action
Planning
Workgroups
Tribal Action Plan (TAP)
Minimum Program
Standards
Native Youth
Educational Services
Inventory/Resources
Newsletter/Website
Resource Navigation to
Native Specific Data Sets
56
TLOA Responsibilities
• Scope of the problem, HHS,
IHS, DOJ
• Identification of programs,
HHS, IHS DOJ
• Minimum program
standards, HHS, HIS, DOJ
• Assessment of resources,
HHS, HIS, DOJ
• TAP development, IHS, BIA,
OJP
• Newsletter, DOI
• Law enforcement and
judicial training, BIA, DOJ
• Emergency medical
assistance, BIA
• Emergency shelters, BIA
• Child abuse and neglect, BIA
• Juvenile detention centers,
HHS, DOI, DOJ
• Model juvenile code, DOI,
DOJ
IASA Inter-departmental
Coordinating Committee
58
Executive Steering Committee
Chair: SAMHSA/OIASA
Co-Chairs: IHS OJP OTJ BIA BIE DoEd
TAP Workgroup
Minimum Program
Standards Workgroup
Chair: SAMHSA
Chair: SAMHSA
Chair: IHS
Communications
Workgroup
Chair: BIA
Inventory/Resources
Workgroup
Native Youth Educational
Services Workgroup
Chair: BIE
Both challenge and opportunity.
The challenge today is to capture the
opportunity, via TLOA, to form a more active
and committed partnership that
demonstrates how Federal Partners and
Tribes can strengthen work relations. This
approach will embrace the value of native
culture and practices, while strengthening the
need for mutual respect and accountability.
59
Why do we need to do this?
60
Establishing the Continuum of Need/Care
Tribes
Planning
TAP’s
Comprehensive
Strategy
Practice
Management
Standards
Prevention
Intervention
Treatment
Recovery
Support
Outcome
Evaluation
IntraConnectivity
School- Based
Health
Centers
Justice
Integrated
Service
Delivery
Menu of
Choices
Data
Workforce
Development
Right Time
Right Student
Right Service
Salient
Factors that
Support
Change
Sustainable
Evidence of
Success
Alternatives
to
Incarceration
Model &
Technique
Infra-structure Needed to Support this Continuum
61
Start with A Plan
… and work your plan
62
Tribal Action Plans
(TAP’s)
The TAP
Workgroup is
assigned via MOA
by the IASA
Interdepartmental
Coordinating
Committee.
Responsibilities:
1.
2.
3.
4.
5.
Establish operating framework
and provide guidelines for Tribes
consistent with requirements of
available Federal resources.
Develop inventory of current
proven strategies (practice-based
models).
Manage overall coordination of
Tribal requests for assistance in
development of TAPs.
Coordinate assistance to Tribes as
deemed feasible.
Collaborate with the Inventory
Workgroup in developing
appropriate responses back to
Tribal entities seeking assistance.
Current Status
What is different with this TAP
• It is a Strategic Public Health and Safety
planning process.
• It focuses on Substance Abuse, as the number
one contributing factor to poor health,
suicide, violence and hopelessness within
Native Nations.
Value of Tribal Action Planning?
• Draws the community together for a critical
purpose
• It becomes a guided community process for
determining the continuum of need that is
matched with necessary resources
• Builds or strengthens service infrastructure
• Helps the tribe to gain optimal position in the
shifting funding environments i.e. ACA
Improved Outcomes
• Increased collaboration vs. silos/gaps in services
results in Holistic Healing and strengthened
community partnerships
• Increases access to integrated services
• Improves Community mental health and wellness
• Decreases chances for provider burn out
• Creates more efficient practice protocols, which
translates to cost effective care
• Increases chances for program and fiscal
sustainability
A Tribal Action Planning Process
TLOA/TAP
STORY
POSITIVE
RESOURCES
• Acknowledge The Importance And Positive Influence
• Impact For Grants, Funding, & Congressional Requests
• Realistic Dilemma Within Indian Country
• Gap in Services With A Desire To Improve Wellness
• Current Champions Within The Community
• Desire to Improve Wellness Using Holistic Approaches
A Tribal Action Planning Process
5 STEPS TO
TAKE
HANDOUT
MATERIAL
PAYOUTS
• Technical Assistance
• Learning Communities
• Successful Execution
• Illustration Of Obtainable & Realistic Goals
• Increased Access To Effective Services/Improved Wellness
• Sustainability, Cost Effective, Partnerships
Tribal Action Planning Guidelines
• Tribal leadership passes
and submits a
resolution, along with
• Request for technical
assistance to conduct
strategic planning
consultation
• OIASA will connect
Tribe(s) to TA resources
• OIASA will track the
plan to ensure that TA
action is taken
• Tribes may submit their
Tribal Action/Strategic
Plan to OIASA, who will
maintain a record of all
plans submitted.
A gracious example offered by;
• The Northwest Portland Area Indian Health
Board, has generously given permission to the
IASA Interdepartmental Coordinating
Committee and SAMHSA to use their tribal
action planning process as a working example
intended to benefit other tribes who are on
the same journey of creating their own
destiny.
NPAIHB -Action Planning Process
1.
Review Epidemiology: Rates, Demographics, Risk and
Protective Factors
2.
Gather Information about Causal Factors and Regional
Capacity
3.
Determine Region’s Readiness Level
4.
Align Action Plan activities to the region’s
Capacity/Readiness using the Socioecological Model
5.
Implement and Evaluate Strategies to Create Community
Change
Community Readiness
1. Community Efforts
2. Community Knowledge
of the Efforts
3. Leadership
4. Community Climate
5. Community Knowledge
about the Issue
6. Resources Related to the
Issue
A&D Prevention: Goals
Increase
Tribal
Capacity
Improve
Intertribal &
Interagency
Communication
Increase
Knowledge&
Awareness
Improve
Tribal
Policies
THANK YOU
Rod Robinson (N. Cheyenne)
Director, Office of Indian Alcohol and Substance Abuse
Substance Abuse and Mental Health Services Administration
[email protected]
[email protected]
(240) 276-2497
www.samhsa.gov/tloa